1Formulas and methods
Infection control & patient safety
Method
- Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
- Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
- Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
- Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
- Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
2Practice problems
1.Infection control & patient safetyMedium
Which assessment is most important while a patient is in wrist restraints?
- AThe patient’s hearing in both ears with a watch test
- BCirculation, sensation and skin beyond the restraint
- CThe patient’s height and weight
- DThe patient’s food and drink preferences for the day
2.Infection control & patient safetyHard
A patient with severe immunosuppression after a stem cell transplant is in a protective environment. Which item should not be brought into the room?
- AThe patient’s own clean clothes
- BFresh flowers or potted plants
- CA family photo in a frame that has been wiped clean
- DA clean, disinfected tablet computer
3.Nursing fundamentalsMedium
Which medicine commonly causes constipation?
- ACodeine
- BLactulose
- CDocusate
- DSenna
4.Nursing fundamentalsHard
A patient rescued from a house fire has a pulse oximetry reading of 99% but is drowsy and has a headache. Why may the reading be falsely reassuring?
- AThe patient's heart rate is too fast for the device to give an accurate reading
- BCarbon monoxide bound to haemoglobin is read by the oximeter as oxygen
- CBurns make the skin conduct light better
- DSmoke makes the oximeter read too low
5.MicrobiologyMedium
What is the incubation period?
- AThe time between infection and the first symptoms
- BThe time a culture needs in the laboratory
- CThe time an antibiotic takes to work
- DThe time during which a patient remains infectious to others
6.MicrobiologyHard
Which process can produce a completely new influenza A subtype that causes a pandemic?
- AAntigenic drift through gradual accumulation of point mutations
- BLysogenic conversion by a bacteriophage
- CTransformation with free DNA
- DAntigenic shift through reassortment of gene segments
3Solutions
1.Infection control & patient safety
Answer: B · Circulation, sensation and skin beyond the restraint
Why this is the answer
Restrained patients are checked often for circulation, sensation, skin condition, comfort, fluids and toileting, and the restraint is released at regular intervals for movement according to policy.
B · Circulation, sensation and skin beyond the restraint
2.Infection control & patient safety
Answer: B · Fresh flowers or potted plants
Why this is the answer
Fresh flowers and plants can carry molds such as Aspergillus and water-borne bacteria, which can cause serious infections in severely immunocompromised patients. Clean, wipeable personal items are usually allowed.
B · Fresh flowers or potted plants
3.Nursing fundamentals
Answer: A · Codeine
Why this is the answer
Opioids such as codeine and morphine slow gut movement and commonly cause constipation. Senna, lactulose and docusate are laxatives.
4.Nursing fundamentals
Answer: B · Carbon monoxide bound to haemoglobin is read by the oximeter as oxygen
Why this is the answer
Carboxyhaemoglobin absorbs light much like oxyhaemoglobin, so standard pulse oximeters overestimate oxygen saturation. Arterial blood gas with co-oximetry is needed, and high-flow oxygen is given.
B · Carbon monoxide bound to haemoglobin is read by the oximeter as oxygen
5.Microbiology
Answer: A · The time between infection and the first symptoms
Why this is the answer
The incubation period runs from exposure to the onset of symptoms. People can sometimes already transmit the infection during it.
A · The time between infection and the first symptoms
6.Microbiology
Answer: D · Antigenic shift through reassortment of gene segments
Why this is the answer
When two different influenza A viruses infect the same cell, their segments can mix, giving new haemagglutinin or neuraminidase combinations. Few people are immune, so pandemics can follow. Drift causes the smaller yearly changes.
D · Antigenic shift through reassortment of gene segments